BRGMC COO Edgardo Tenreiro offered a frank assessment of his hospital's response to the shooting, including the flaws.

"The No. 1 thing we learned is we didn't have an appropriate emergency code to notify staff," he says. "The traditional Code White indicates a violent patient. But in cases of an active shooting you don't want to use Code White because staff is going to respond to a Code White. What you want in a situation with a shooter is for staff not to respond, other than security."

BRGMC now refers to shootings as Code Silver, and staff understand that their job is not to backup colleagues, but to ensure that that patients and visitors in their immediate area are safe and locked down. Code Silver also allows employees to provide an explanation for patients and visitors of what could be a stressful situation, with the possibility that they will have to be evacuated, or that heavily armed SWAT police will conduct room-to-room searches.

Second, Tenreiro says make sure your hospital has the ability to establish a mobile emergency command center outside of the hospital, so that you can communicate with employees inside the hospital during a locked down.

"We had to improvise a command center outside on a sidewalk next to the SWAT command," Tenreiro says. "The fact that we didn't have the direct command center communication made it very difficult for us to let folks inside the hospital know the progress that was being made in clearing the hospital."

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